I have sleep apnea. The gasping kind. Could I still be a candidate for a Lower Face Lift?

Question

I am a 55 yr woman. I cannot sleep on my back but propped up on a wedge because of my sleep apnea. I am careful not to take any cough medicine as this makes me drowsy and I end up waking up gasping for air. Would I be so sedated that I may stop breathing while you do surgery on me? And are you prepared for a situation like this? What would you do if this happened? I really do want a Lower Face Lift but I need to feel sure that this surgery will not cause me any problems. Thank you!

Jason Emer, MD · Answer

Yes with apnea, as long as you have medical clearance, you can do a face and/or neck lift.  With significant neck sagging you would need a neck/face lift with muscle tightening (platysmaplasty). at the same time lasers (fraxel,  co2 or erbium( or microneedling RF (fractora, intensif) can be . performed to improve the crepe skin or wrinkles.  You need a formal consultation, as the neck can be treated with a combination approach:
1. micro needling and lasers for texture
2. botox, disport or xeomin to help platysmal bands
3. intensif or fractora RF microneedling for crepe skin and lifting
4. fillers like belotero, restylane silk, juvederm volbella to improve lines and folds
5. neck/face lifting if sagging is prominent or early starting +/- platysmaplasty (muscle tightening)
6. J plasma/Renuvion, thermiRF, inmode facetite for internal tightening
7. ultherapy and thermage for external tightening
8. regular Venus legacy, exilis ultra, or inmode forma treatments with facials to maintain tightness
9. PDO novathreads or silhouette instalift cone threads for lifting and long-term collagen production
see an expert for a full evaluation and treatment plan based on your individual situation and goals.
Best, Dr. Emer.

Cameron Chesnut, MD, FAAD, FACMS · Answer

This can absolutely be performed and should be discussed with your surgeon. Sometimes we can do full procedures with local anesthesia, avoiding the sedative issues. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.Cameron Chesnut #realself hall of fame Physician

Brian K. Machida, MD, FACS · Answer

Depending upon the severity of the sleep apnea, you may want to be careful about general anesthesia. With severe sleep apnea and a general anesthetic, you won’t have a problem during the surgery....just possibly before and after a general. Depending on your anatomy, your intubation may be difficult. Post op after a general is usually when there might be a problem in recovery with apnea.With IV sedation, it will be important to monitor the level of sedation. But usually with careful attention and good monitoring, there shouldn’t be a problem but it depends on your apnea severity.With a local aesthetic and oral sedation, this would likely be the safest  in view of your apnea. In all cases, careful monitoring during the procedure should be done.After the surgery in any of the above cases, be careful with the use of your pain medicine, ensure you are always on the correct sleeping position, and use your c pap if being used now.

Alejandro J. Quiroz, MD · Answer

Thank you for the question. The answer is yes. Even if you have sleep apnea you can have a face and neck lift. You need a full physical exam and also be certain that you select a Accredited Surgical Facility and a Board certify plastic surgeon

Victor Chung, MD · Answer

Sleep apnea is a medical condition in which a persons has pauses in their breathing while they are asleep. This is a condition that should be brought up with the anesthesiologist, the doctor who will be monitoring you during surgery. Severe cases of sleep apnea require extra precautions. I would discuss this with your surgeon for any procedure along with the anesthesiologist for a safe and happy result. Safety comes first.

William Portuese, MD · Answer

Yes, it is possible to undergo a facelift procedure with sleep apnea. Always best to discuss this extensively with your surgeon and anesthesiologist.

Francis R. Palmer, III, MD (retired) · Answer

Hi, I understand your concerns.  It might make more sense to have a minimally, invasive SMAS facelift that can be performed in 90 minutes or less using a local anesthetic.  This would allow you to be awake and breathe normally and on your own.  If you have a larger, more invasive facelift this will most likely require a general anesthetic with airway protection.  I have performed many SMAS facelifts for over 30 years and have performed many minimally, invasive SMAS facelifts.  If you have "jowls” these are sagging facial tissues and the main indication for some form of a SMAS facelift.  The underlying SMAS layer, of the face, must be dissected, lifted, trimmed and re-sutured (not merely folded or suspended with threads or sutures that will not last).  The excess skin is then removed and the facelift incisions closed.
 My most popular SMAS facelift is the minimally invasive, short incision SMAS facelift that has all the benefits of more invasive facelifts (traditional, mid-face, deep plane, cheek lift and subperiosteal facelifts) but with these added benefits:
very small incisions and no incisions extend or are placed within the hair.
minimal tissue dissection  less bruising and swelling  rapid recovery ( several days instead of weeks or months with the more invasive type facelifts mentioned)
can be performed in 90 minutes or less, with or without general anesthesia
proper SMAS Imbrication technique
no incisions within the hair  no hair loss
excess fat can be removed from the face and neck
excess skin removed from the face and neck
cheeks, chin and jaw line can be augmented with dermal fillers (I prefer Restylane Lyft) or facial implants
most patients fly back home to parts all over the world in as little as 3 days post-op
 I combine facial shaping with every facelift procedure.  When jowls are present, these should be done in concert and not alone or separately in order to create a naturally, more attractive face. Following my beauty principles, women look the most feminine, youthful and attractive with heart shaped faces.  Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.
 A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.  I have found placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick and highly effective.Hope this helps.

I have sleep apnea. The gasping kind. Could I still be a candidate for a Lower Face Lift?

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